Kelley Jana

Provided subject matter expertise and leadership in support of CMS, CDC, and ONC quality and public health initiatives. Prepared a report to Congress on the use of section 1135 waivers during the COVID-19 Public Health Emergency. Led meetings with national pharmacy CEOs and general counsel to manage pharmacy COVID-19 testing programs in a dynamic environment.

Served as clinical SME supporting CMS’s PQRS-DV program. Reviewed medical charts against PQRS specs, identified reporting errors, and advised CMS on measure performance and implementation challenges. Developed educational materials for eligible professionals and trained new hires on validation and reporting processes.

Coordinated care for patients enrolled in CareFirst’s Medical Home program by identifying chronic conditions, care gaps, and social needs through medical record review. Developed clinical reports and coordinated services such as behavioral health, home health, and community resources. Served as liaison between patients, primary care providers, and care teams to ensure successful plan implementatio

Managed nursing operations for the Rehab Unit, ensuring adherence to the State’s Nurse Practice Act and overseeing the nursing process. Conducted mock surveys to ensure compliance with local, state, and federal healthcare regulations. Supervised complex cases, providing guidance to nursing staff and ensuring the best quality of care through critical thinking.

Managed admissions and marketing efforts for the assisted living and skilled nursing facilities, building referral relationships with hospitals and community organizations. Developed and maintained key referral sources to support census growth and financial goals. Certified Delegating Nurse for Assisted Living, conducting assessments and training Med Techs.

Held progressive roles across Case Management, ICU/Trauma, and Med/Surg units, providing high-quality clinical care, resource coordination, and staff education. Led case management efforts for the Cardiothoracic and Cardiac Care Units, ensuring appropriate resource use, medical necessity reviews, and collaboration with care teams to optimize outcomes. Delivered critical care to complex patients in